Clonidine has been used for more than 40 years to treat high blood pressure. It has also been valuable in helping people manage symptoms associated with certain types of substance withdrawal, specifically withdrawal from opioids like heroin, fentanyl and hydrocodone.
What Is Clonidine?
Clonidine (brand names Catapres, Catapres-TTS and Kapvay) is an antihypertensive drug that has been used to manage high blood pressure for decades. It is typically used in combination with other drugs to manage blood pressure.
Clonidine is also approved in the U.S. to treat attention-deficit/hyperactivity disorder (ADHD) in children. It can manage some symptoms associated with Tourette syndrome and pain associated with cancer as well.
Off-label uses for clonidine include the management of post-traumatic stress disorder (PTSD), anxiety and insomnia. In addition, clonidine can help control hot flashes in menopausal women, relieve restless leg syndrome and prevent vascular migraine headaches.
Why Is Clonidine Used for Withdrawal?
Clonidine can relieve symptoms associated with detox and withdrawal from opioid use disorders. However, it is less effective in treating alcohol or benzodiazepine withdrawal symptoms. In recent years, clonidine has largely been replaced by other, more effective drugs in managing withdrawal symptoms. However, clonidine still has a place in the management of withdrawal symptoms.
Clonidine helps manage symptoms of withdrawal like high blood pressure, sweating and tremor and reduces cravings for substances. Since clonidine has virtually no potential for addiction, it is used in people that would be at risk of continued drug abuse with controlled substances like buprenorphine.
How Does Clonidine Work?
Clonidine is described as a centrally acting alpha-agonist that stimulates alpha-adrenoreceptors in the brain stem. This means that clonidine activates pathways in the brain responsible for maintaining normal blood pressure throughout the body.
Clonidine’s main effect is to reduce vascular resistance, which allows blood to flow throughout the body more easily. This can reduce hypertension and normalize blood pressure. If vascular resistance is reduced too much, however, dizziness and fainting may occur. Clonidine effectively treats high blood pressure, especially in people who have not responded well to other antihypertensive drugs.
Clonidine works for other conditions because the alpha-receptors are involved in many regulatory processes in the body. The alpha-receptors throughout the body regulate sweating, tremor, anxiety and pain, among other things.
Clonidine for Withdrawal Symptoms
Clonidine has been successful in managing uncomfortable symptoms associated with detox and withdrawal from opioids, benzodiazepines and alcohol. The medication is used to treat withdrawal symptoms in a few different ways.
Clonidine works by reducing the severity of withdrawal symptoms like high blood pressure, nausea, sweating, diarrhea, cramps, anxiety and cravings.
Alcohol use disorders are associated with potentially dangerous withdrawal symptoms, including seizures and delirium tremens. The first-line treatment for alcohol withdrawal is benzodiazepines.
Clonidine has been used to help people manage alcohol withdrawal symptoms, but it is typically administered with a sedative or benzodiazepine. Clonidine alone is generally not enough to control the potentially dangerous symptoms of moderate to severe alcohol withdrawal.
Buprenorphine is the current gold standard for medication-assisted therapy for opioid use disorders. It is typically provided under the brand name Subutex or, when naloxone is included, Suboxone.
A recent study showed that when patients with opioid withdrawal symptoms were provided with either clonidine or buprenorphine, those who took buprenorphine were more likely to be in recovery treatment one month later. These results indicate that buprenorphine is more effective at helping people stay in recovery in the first month after quitting opioids.
These preliminary findings do not mean that clonidine has no role in treating opioid use disorders. Many emergency departments continue to administer clonidine to incoming patients. However, the data suggests that switching clients from clonidine to buprenorphine may increase recovery success rates.
How Is Clonidine Administered?
Clonidine can be administered in several ways, including:
- Transdermal patch, which provides a consistent dose of clonidine over the course of seven days. This method is very common for people facing withdrawal symptoms.
- Immediate-release tablets, often used to help people with opioid withdrawal symptoms.
- Extended-release tablets, used less frequently to help people manage withdrawal symptoms.
- Injectable solutions, which are not used in people suffering from withdrawal symptoms. This formulation is used for epidural pain management.
Clonidine Dosage for Withdrawal
Each of these formulations comes in several doses. The specific clonidine withdrawal dosing depends on the specific circumstances, but target doses for treating opioid withdrawal symptoms are typically between 0.1 mg and 0.3 mg per day.
Clonidine Side Effects
Clonidine is associated with a number of potential adverse effects, but they tend to become less severe with continued use. Commonly reported side effects of clonidine use include:
- Sedation
- Dizziness
- Headache
- Fatigue
- Nausea
- Diarrhea
- Sexual dysfunction
- Abdominal pain
- Anxiety
- Mood swings
- Dry mouth
Less common but more serious side effects may include:
- Depression
- Slow heart rate
- Severe hypotension (characterized by fainting or extreme dizziness)
- Swelling, often around the face or lips but sometimes in other parts of the body
Clonidine Interactions
Clonidine is generally well tolerated. However, some drugs should not be taken with clonidine due to the potential for drug interactions:
- Central nervous system depressants (alcohol, benzodiazepines, opioids, barbiturates or other drugs that have a sedating effect)
- Beta-blockers
- Calcium channel blockers
- Amitriptyline
- Tricyclic antidepressants
Clonidine and Alcohol
Clonidine and alcohol should not be taken together because both of these drugs can produce sedation and drowsiness. Alcohol is a depressant and can affect blood pressure as well as slow thinking, breathing and heart rate. Alcohol is a drug with a high risk of overdose and death. Clonidine can increase this risk and has a high likelihood of causing a slow heart rate.
Frequently Asked Questions About Clonidine for Withdrawal
No, clonidine is not a controlled substance. However, clonidine is only available by prescription and is known as a legend drug.
No, clonidine is not a benzodiazepine. Benzodiazepines are a class of medications that are all controlled substances, meaning they have the potential for abuse and addiction. Clonidine can treat symptoms of drug withdrawal, like benzos, but it is a different type of drug.
No, Xanax is the brand name for alprazolam, a benzodiazepine. Xanax is a controlled substance, while clonidine is not. Xanax primarily treats anxiety, while clonidine primarily treats high blood pressure.
Drugs are eliminated from the body in about five half-lives. The half-life of oral clonidine is 12–16 hours, so it leaves the body in 60–80 hours. Other formulations may last in the body for longer.
The immediate-release oral tablet starts working in about one to three hours. Other formulations will take longer to start working.
Finding Treatment for Opioid and Alcohol Withdrawal in Orlando, FL
While more modern medications have largely replaced clonidine, clonidine is still helpful in relieving the severity of some withdrawal symptoms. It is especially helpful for mild to moderate withdrawal symptoms associated with heroin or opioid use disorders.
Clonidine is generally safe when taken as prescribed. However, there is some risk for dependence if misused. Overdose is also possible, though it is generally not associated with long-term damage or fatalities. People taking clonidine should follow the direction of a medical professional and adhere to the prescribed dose and dosing frequency.
If you or someone you love is struggling with a substance use disorder, help is available. Orlando Recovery Center is able to help people successfully overcome the first days of detox and withdrawal. We also offer high-quality residential and outpatient treatment programs that help patients succeed in long-term recovery. Contact us today to learn more about plans and programs that can work well for you.
College of Psychiatric and Neurologic Pharmacists (CPNP). “Clonidine (Kapvay and Catapres).” NAMI, January 2016. Accessed May 5, 2022.
Fluyau, Dimy; Revadigar, Neelambika; & Manobianco, Brittany E. “Challenges of the pharmacological manage[…] and discontinuation.” Therapeutic Advances in Psychopharmacology, February 2018. Accessed May 5, 2022.
Food and Drug Administration (FDA). “Catapres Package Insert.” Boehringer Ingelheim International, October 2009. Accessed May 5, 2022.
Hallare, Jericho. “Half Life.” StatPearls, January 2022. Accessed May 9, 2022.
Hoffman, Robert S. & Weinhouse, Gerald L. “Management of moderate and severe alcoho[…]withdrawal syndromes.” UpToDate, September 2019. Accessed May 5, 2022.
Seale, J. Paul; Dittmel, Trent; Sigman, Erika J.; Clemons, Holly; & Johnson, J. Aaron. “Combined Abuse of Clonidine and Amitript[…]aintenance Treatment.” Journal of Addiction Medicine, November 5, 2014. Accessed May 5, 2022.
Srivastava, Anita, et al. “Buprenorphine in the emergency departmen[…]of opioid withdrawal.” Canadian Family Physician, May 2019. Accessed May 5, 2022.
U.S. National Library of Medicine. “Clonidine.” MedlinePlus, May 15, 2017. Accessed May 5, 2022.
Yasaei, Rama & Abdolreza, Saadabadi. “Clonidine.” StatPearls, January 2022. Accessed May 5, 2022.
World Health Organization. “Clinical Guidelines for Withdrawal Manag[…]e in Closed Settings.” 2009. Accessed May 5, 2022.
The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.